GPs urged to check BP in both arms

Abstract

MedWire News: Experts have urged GPs to check patients' blood pressure (BP) in both arms, after research demonstrated that a marked difference in BP levels between arms signals an increased risk of both central and peripheral vascular disease.

In a systematic review and meta-analysis, Dr Christopher Clark (University of Exeter) and colleagues found that a difference of 15 mmHg or more in systolic BP between arms is associated with a 2.5-fold increased risk of peripheral vascular disease. This difference was also associated with smaller, but still significant, increases in both cerebrovascular disease and cardiovascular mortality risks.

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Moreover, in a separate meta-analysis, they found that a difference of just 10 mmHg or more between arms was associated with a similar (2.4-fold) increase in risk of peripheral vascular disease.

Reporting their findings in The Lancet, the authors caution that all but one of the cohorts in the study were recruited from vascular or renal clinics, so the results may not apply to the wider population of patients without cardiovascular risk factors.

But they conclude that their findings suggest that a difference of 10 or 15 mmHg in systolic BP between arms "could identify patients at high risk of asymptomatic peripheral vascular disease and mortality who might benefit from further assessment".

BP measurement in both arms is recommended in guidelines, but has been poorly justified and therefore barely adopted in primary care, explain Professor Richard McManus (University of Oxford) and Professor Jonathan Mant (University of Cambridge) in a related editorial. They maintain that "ascertainment of differences should become part of routine care, as opposed to a guideline recommendation that is mostly ignored".